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. 2001 Oct;85(10):1225–1230. doi: 10.1136/bjo.85.10.1225

Pupillary autonomic denervation with increasing duration of diabetes mellitus

M Cahill 1, P Eustace 1, V de Jesus 1
PMCID: PMC1723745  PMID: 11567969

Abstract

BACKGROUND/AIMS—The autonomic pupillary changes in type I and II diabetic patients without clinical evidence of diabetic autonomic neuropathy (DAN) were compared with age matched controls. The relation between pupillary and cardiovascular autonomic function was assessed in the diabetic patients.
METHODS—A case-control study was performed with diabetics grouped according to type and duration of diabetes. Static infrared pupillography was used to compare mean dark adapted pupil size and mean percentage changes in pupil size with pilocarpine 0.1% and cocaine 4% in the diabetic and control groups. All diabetic patients underwent cardiovascular autonomic function assessment using the Valsalva ratio, the 30:15 ratio, and testing for orthostatic hypotension.
RESULTS—In total, 72 type I and 69 type II diabetic patients were compared with 120 controls. Mean dark adapted pupil size was significantly smaller in diabetic groups than controls. Except for type I diabetics with disease for less than 5 years, all patient groups had significantly greater mean percentage constriction in pupil size in response to dilute pilocarpine than controls. There was no significant difference between the mean percentage dilatation in response to cocaine 4% in diabetics and controls. A high proportion of patients had normal cardiovascular autonomic function particularly when this was assessed with the Valsalva ratio.
CONCLUSIONS—Denervation hypersensitivity to dilute pilocarpine is a result of damage to the pupillary parasympathetic supply of diabetic patients. This occurs before the pupillary sympathetic pathway is affected, it can be detected early in the disease, and it may be a possible explanation for the small pupil size seen in diabetic patients. Pupillary autonomic dysfunction occurs before cardiovascular autonomic changes and detection of pupil denervation hypersensitivity to dilute pilocarpine is an inexpensive way to detect early DAN.



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Figure 1  .

Figure 1  

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Pupillary autonomic denervation with increasing duration of diabetes mellitus. (A) Dark adapted pupil size, IDDM versus controls. (B) Dark adapted pupil size, NIDDM versus controls.

Figure 2  .

Figure 2  

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Pupillary autonomic denervation with increasing duration of diabetes mellitus. (A) Percentage pupillary constriction with pilocarpine 0.1%, IDDM versus controls. (B) Percentage pupillary constriction with pilocarpine 0.1%, NIDDM versus controls. Note: All minimum values were zero in both patients and controls in (A) and (B)

Figure 3  .

Figure 3  

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Pupillary autonomic denervation with increasing duration of diabetes mellitus. (A) Percentage pupillary dilatation with cocaine 4%, IDDM versus controls. (B) Percentage pupillary dilatation with cocaine 4%, NIDDM versus controls.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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